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H. pylori Eradication — UKMLA MCQ

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ModerateGastroenterologyH. pylori EradicationUKMLAMRCGP AKTPARAPSA

A 46-year-old man has confirmed Helicobacter pylori infection and has not previously received eradication treatment. He is not allergic to penicillin. He completed a course of metronidazole 2 months ago for a dental infection but has never taken clarithromycin. Which is the most appropriate first-line eradication regimen?

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Correct answer: D — PPI plus amoxicillin plus clarithromycin for 7 days

The correct answer is D. NICE recommends a 7-day, twice-daily course of a PPI, amoxicillin and either clarithromycin or metronidazole for first-line H. pylori eradication in people without penicillin allergy. Previous exposure to either antibiotic should guide the choice; this man's recent metronidazole exposure favours clarithromycin. Option C unnecessarily reuses metronidazole. Option B is the penicillin-allergy regimen. Bismuth quadruple therapy is reserved for specified circumstances, including certain patterns of penicillin allergy and previous antibiotic exposure, so D is inappropriate here. NICE recommends 7 rather than 14 days for this first-line regimen, excluding E.

Reference: National Institute for Health and Care Excellence. CG184, Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management, section 1.9, recommendation 1.9.4. Published 2014; current guideline with subsequent amendments. https://www.nice.org.uk/guidance/cg184/chapter/Recommendations